Beliefs about consequences
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Often regarded as core to clinical reasoning, this domain covers the perceived benefits and harms of a clinical action. In some contexts it can also include consequences for the clinician such as workload, pay, career progression, or for the hospital or health service.
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Behavioural regulation
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Includes the ‘how’ of changing clinical practice: what are the practical strategies that would facilitate or hinder uptake of a new practice.
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Beliefs about capabilities
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How confident clinicians are that they could change their practice effectively.
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Emotion
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Includes issues such as work stress, patient anxiety and other emotional factors that may help or hinder the uptake of new approaches to care.
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Environmental context/resources
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Includes the physical (including financial) issues that may limit change, including staffing levels and time as well as equipment or space.
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Knowledge
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Knowledge of the field (that is, whether there is adequate evidence) and individuals’ knowledge of the evidence or of a guideline.
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Memory, attention and decision processes
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The level of attention that is needed to perform the key clinical action (that is, whether forgetting is likely to be a problem) and the processes by which clinical decisions are made by individuals and teams.
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Motivation and goals
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The relative priority that is given to one clinical issue, compared with other demands.
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Social/professional role and identity
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The clinical thinking and norms of a particular profession.
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Skills
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Covers the possibility that new skills would be required by the staff that are required to implement a new procedure.
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Social influences
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The influence of other individuals or groups on clinical practice; for example, patients, patients’ families, pressure groups.
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Nature of the behaviours |
Some new practices are very similar to current practice and so are easier to implement than new practices that require a dramatic change in ways of working. |